{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T16:37:11Z","timestamp":1793205431071,"version":"4.5.0"},"reference-count":43,"publisher":"Bioscientifica","issue":"5","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The high prevalence of thyroid nodules and the frequent occurrence of nondiagnostic (ND) results on fine-needle aspiration (FNA) necessitate malignancy risk stratification to balance cancer detection while avoiding unnecessary repeat biopsies. This study evaluated malignancy rates and management strategies for nodules with ND cytology, stratified by the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study analyzed 342 consecutive patients with initial ND ultrasound-guided (USG) thyroid FNA at a high-volume, two-practitioner clinic between January 2019 and June 2024. Data collected from chart reviews included Bethesda cytopathology classifications, management approaches, and final histopathological diagnoses when available.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 3,717 thyroid FNAs performed during the study period, 342 (9.2%) were ND on initial sampling. The TI-RADS (TR) distribution for ND nodules was as follows: TR1 9.6%, TR2 9.9%, TR3 28.1%, TR4 45.3%, and TR5 7.0%. Initial management comprised repeat FNA in 170 (49.7%) patients, ultrasound (US) surveillance in 101 (29.5%), and surgery in 17 (5.0%); 54 (15.8%) patients were lost to follow-up. Of the repeat FNAs, 47 (27.6%) remained ND. Of the 33 surgical cases, malignancy was identified in six (1.8%) index nodules with initial ND cytology. Five malignancies occurred in TR4 nodules and one in a TR5 nodule. Importantly, no malignancies were identified among the 17 resected TR1\u20133 nodules.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>For experienced practitioners in a high-volume clinic, ND thyroid FNA cytology carries a low overall observed risk of malignancy (1.8%). TI-RADS scores should be taken into consideration to guide management decisions for ND cytology nodules between repeat FNA, US surveillance, or surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1530\/etj-26-0237","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:09:08Z","timestamp":1792174148000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-17","source":"Crossref","is-referenced-by-count":0,"title":["Management of nondiagnostic thyroid fine needle aspiration cytology nodules based on TI-RADS risk assessment"],"prefix":"10.1530","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6915-6869","authenticated-orcid":true,"given":"Reettika","family":"Chanda","sequence":"first","affiliation":[{"name":"Department of Radiology, Cumming School of Medicine, University of Calgary 1 , , ,","place":["Calgary, Alberta, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sana","family":"Ghaznavi","sequence":"additional","affiliation":[{"name":"Division of Endocrinology & Metabolism, Department of Medicine, University of Calgary 2 , , ,","place":["Calgary, Alberta, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Timothy","family":"Lysack","sequence":"additional","affiliation":[{"name":"Department of Radiology, Cumming School of Medicine, University of Calgary 1 , , ,","place":["Calgary, Alberta, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moosa","family":"Khalil","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Alberta Precision Laboratories, Cumming School of Medicine, University of Calgary 3 , , ,","place":["Calgary, Alberta, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Neuburger","sequence":"additional","affiliation":[{"name":"Department of Radiology, Cumming School of Medicine, University of Calgary 1 , , ,","place":["Calgary, Alberta, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5934-0961","authenticated-orcid":true,"given":"James N","family":"Scott","sequence":"additional","affiliation":[{"name":"Department of Radiology, Cumming School of Medicine, University of Calgary 1 , , ,","place":["Calgary, Alberta, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"2026102812062576800_bib1","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1111\/j.1365-2362.2009.02162.x","article-title":"Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound 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